Water Efficient Rebate Request Form

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Water Efficient Rebate Request Form
Please correct the field(s) marked in red below:

1
1. Rebate Type 
 *
1. Rebate Type
2
2. Account Number on your Utility Bill
Please Use Format xxxxxx-xxxxx (ex: 012345-67890)
You must enter the correct account number or your request will not be processed.
3
3. Name on Account
4
4. Applicant's First Name
5
5. Applicant's Last Name
6
6. Account Street Address
7
7. Account Zip Code
8
8. Is the mailing address the same as property address? If NO, you MUST fill out the following section.*
 *
8. Is the mailing address the same as property address? If NO, you MUST fill out the following section.*
9
9. Mailing Address
10
10. City
11
11. State
12
12. Zip Code
13
13. Email
14
14. Phone Number
15
15. Alternate Phone #
16
16. Account Type
 *
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